So What Services are Available with Employment and Community First CHOICES? (Part 3)

/ April 12, 2016

By Janet Shouse

About the Authorjanetblog[1]

Janet Shouse is a parent of a young adult with autism, and she is passionate about inclusion, employment of people with disabilities, medical issues related to developmental disabilities, supports and services, public policy, legislative initiatives, advocacy, and the intersection of faith and disability. She wears many hats at the Vanderbilt Kennedy Center, including one as a disability employment specialist for TennesseeWorks.

Our hope is that this weekly blog will offer information you want to know, so if you have a question you want answered about employment for people with disabilities or other mysteries of the world of work, please email me at


Since the Employment and Community First CHOICES program is focused on helping people with intellectual and developmental disabilities find and maintain employment, many of the services are aimed at that goal. But sometimes just knowing the name of a service isn’t very enlightening.

Today, let’s look specifically at the employment services and supports offered. ECF CHOICES includes 14 different employment-focused services and supports:

1. Exploration– Designed to help a person make an informed choice about whether he or she wishes to pursue individualized integrated employment or self-employment. This service will help identify a person’s specific interests and aptitudes for paid work, and may include business tours, informational interviews and/or job shadowing to learn about local opportunities that may be a good fit. This service also includes introductory education on numerous work incentives for individuals receiving publicly funded benefits (e.g. SSI, SSDI, Medicaid, Medicare, etc.) and on how Supported Employment services work.

2. Discovery – Designed to help a person who wants to pursue integrated employment or self-employment but for whom more information is needed to determine the path to employment. Discovery involves an analysis of the person in relation to:

  • Strongest interests toward one or more specific aspects of the labor market;
  • Skills, strengths and other contributions likely to be valuable to employers or valuable to the community if offered through self-employment;
  • Conditions necessary for successful employment or self-employment.

The  person will be assisted to apply to Vocational Rehabilitation (VR) for services to obtain integrated employment or self-employment. The Discovery Profile created by this analysis will be shared with VR staff to help develop an Individual Plan for Employment (IPE), which is like an IEP for employment.

3. Situational Observation and Assessment– Designed to assess an individual’s interpersonal skills, work habits and vocational skills through community volunteer experiences and/or paid integrated work experiences that are arranged and related to the interests, preferences and skills of the job seeker. This service involves a comparison of the performance of the individual being assessed with core job competencies and duties required of a skilled worker in order to determine the skills needed by the job seeker to be successful in that work environment. (The individual shall be reimbursed at least the minimum wage and all applicable overtime for work performed, except as permitted pursuant to the Fair Labor Standards Act for unpaid internships.) This service is limited to 30 days and results in a report to help guide decisions about the Job Development Plan or Self-Employment Plan.

4. Job Development Plan– Designed to create a detailed plan for Job Development. This service includes a planning meeting with the individual and other key people who will be instrumental in supporting the individual to becoming employed. This service culminates in a written plan that incorporates the results of Exploration, Discovery, and/or Situational Observation and Assessment, if previously authorized.

5. Self-Employment Plan – Designed to create a detailed plan for the start-up phase of Self-Employment. This service results in the development of a business plan, including potential sources of business financing (such as VR, Small Business Administration loans, PASS plans), given that Medicaid funds may not be used to cover the capital expenses associated with starting a business.

6. Job Development Start-Up – Support to obtain a competitive or customized job in an integrated setting in the general workforce, for which an individual is compensated at or above the minimum wage. The Job Development strategy should reflect best practices and be adjusted based on whether the individual is seeking competitive or customized employment.

7. Self-Employment Start-Up – Support in implementing a self-employment business plan.

8. Job Coaching for Individual Integrated Employment– Designed to identify and provide services and supports that assist the individual in maintaining integrated employment that pays at least minimum wage. Job coaching includes supports provided to the individual and his/her supervisor and/or co-workers, either remotely (via technology) or face-to-face. Supports must be guided by a Job Coaching Fading Plan that incorporates a mix of best practices for the individual (e.g. instruction to teach the individual to independently complete as much of his/her job duties as possible; assistive technology; and effective engagement of natural supports, including co-workers and supervisor(s) as needed). The goal is that the support from the job coach will “fade” over time. If progress on fading ceases at some point, adaptations to job duties, negotiated with the supervisor/employer, or transition to “Co-Worker Supports” (see #10) may be utilized, if no reduction in hours or hourly pay results.

9. Job Coaching for Self-Employment – Designed to identify and provide services and supports that assist the individual in maintaining self-employment.  Job coaching for self-employment includes supports provided to the individual, either remotely (via technology) or face-to-face. Supports must enable the individual to successfully operate the business (with assistance from other sources of professional services or suppliers of goods necessary for the business). Job Coaching supports should never supplant the individual’s role or responsibility in all aspects of the business.

10. Co-Worker Supports -This service involves a provider of Job Coaching entering into an agreement with an individual’s employer to reimburse the employer for supports provided by one or more supervisors and/or co-workers, acceptable to the individual, to enable the person to maintain employment with the employer. This service cannot include payment for the supervisory and co-worker supports rendered as a normal part of the business setting and that would otherwise be provided to an employee without a disability. Only supports that must otherwise be provided by a Job Coach may be reimbursed under this service category. Co-Worker Supports would be authorized in situations where any of the following is true:

  • If the employer prefers (or the individual prefers and the employer agrees) to provide needed Job Coach supports, rather than having a Job Coach, either employed by a third party agency or self-employed, present in the business. The expectation that over time supports should “fade” should still be in place to maximize independence of the employed individual.
  • At any point in the individual’s employment where needed, Job Coaching supports can be most cost effectively provided by Co-Worker Supports and both the employer and individual agree to the use of Co-Worker Supports. Fading of Job Coaching supports may or may not still be occurring, but Co-Worker Supports should be considered when on-going fading of Job Coaching has stopped occurring.
  • For individuals who are expected to be able to transition to working only with employer supports available to any employee and additional negotiated natural supports, if applicable. In this situation, Co-Worker Supports are authorized as a temporary (maximum 12 months) bridge to relying only on employer supports, and additional negotiated natural (unpaid) supports if applicable, to maintain employment.

11. Supported Employment – Small Group (maximum of 3 persons supported together as a small group) – Designed to provide employment services and training activities to support successful transition to individualized integrated employment or self-employment, or to supplement such employment and/or self-employment when it is only part-time. Minimum staffing ratio is 1:3 for this service.

  • Career planning and exploration activities, Discovery classes/activities, other educational opportunities related to successful job acquisition and working successfully in individualized integrated employment or self-employment must be conducted in appropriate non-disability-specific settings.
  • In the enclave model, a small group of people with disabilities (no more than 3 people) is trained and supervised to work among employees without disabilities at the host company’s work site. Persons in the enclave may work as a team at a single work area or may work in multiple areas throughout the company. The Supported Employment—Small Group provider is responsible for training, supervision, and support of participants. The provider is expected to conduct this service in integrated settings that do not isolate participants from others in the setting who do not have disabilities.
  • In the mobile work crew model, a small crew of workers (no more than three persons with disabilities and ideally also including workers without disabilities) work as a distinct unit and operate as a self-contained business that generates employment for crew members by selling a service. The crew typically works at several locations within the community. The Supported Employment—Small Group provider is responsible for training, supervision, and support of participants. The provider is expected to conduct this service in integrated business, industry or community settings that do not isolate participants from others who do not have disabilities.

12. Career Advancement– Designed to provide career planning and advancement support service for persons currently in individualized integrated employment or self-employment who wish to obtain a promotion and/or a second individualized integrated employment or self-employment opportunity. The service focuses on developing and successfully implementing a plan for achieving increased income and economic self-sufficiency through promotion to higher paying position or through a second individualized integrated employment or self-employment opportunity.

13. Benefits Counseling– Designed to inform the individual (and guardian, conservator and/or family) of the multiple pathways to ensuring individualized integrated employment or self-employment results in increased economic self-sufficiency (net financial benefit) through the use of various work incentives. This service should also debunk myths about loss of benefits and ease concerns related to employment through an accurate, individualized assessment. The service provides information regarding the array of work incentives for benefit programs including Supplemental Security Income, Social Security Disability Income, Medicaid, Medicare, housing subsidies, food stamps, etc. The service also will provide information and education regarding income reporting requirements for public benefit programs, including the Social Security Administration.

14. Integrated Employment Path Services (Pre-Vocational) – Designed to provide learning and work experiences, including volunteering opportunities, where a person can develop general, non-job-task-specific strengths and skills that contribute to employability. Services should be customized to provide opportunities for increased knowledge, skills and experiences specifically relevant to the person’s work goals. Services are intended to teach general skills that lead to individualized integrated employment or self-employment including: ability to communicate effectively with supervisors, co-workers and customers; generally accepted workplace conduct and dress; ability to follow directions; ability to attend to tasks; problem-solving skills and strategies; and general workplace safety and mobility training.

For more in-depth explanations, time limitations and how providers are paid for these services, check out the link on ECF Employment Service Definitions:

(Next week’s blog topic: What other services will be offered in the Employment and Community First CHOICES program and, finally, the answers to some questions.)

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